This page is part of the PACIO Personal Functioning and Engagement Implementation Guide (v1.0.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

Example QuestionnaireResponse: PFEIG-QResponse-Hospital-Admission-Mobility-1

LinkId	Text	Definition	Answer
PFEIG-QResponse-Hospital-Admission-Mobility-1			Questionnaire:http://example.org/Questionnaire/MDS3.0-NC-1.17
Section-37	Functional abilities and goals - admission [CMS Assessment]
Section-37/GG0170_1	Mobility - admission performance during 3 day assessment period [CMS Assessment]
Section-37/GG0170A1	Roll left and right - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA11759-0: Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
Section-37/GG0170B1	Sit to lying - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA11759-0: Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
Section-37/GG0170C1	Lying to sitting on side of bed - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA11759-0: Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
Section-37/GG0170D1	Sit to stand - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA11759-0: Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
Section-37/GG0170E1	Chair/bed-to-chair transfer - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA27665-1: Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.
Section-37/GG0170F1	Toilet transfer - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170G1	Car transfer - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170I1	Walk 10 feet - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170J1	Walk 50 feet with two turns - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170K1	Walk 150 feet - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170L1	Walking 10 feet on uneven surfaces - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170M1	1 step (curb) - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170N1	4 steps - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170O1	12 steps - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170P1	Picking up object - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170R1	Wheel 50 feet with two turns - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
Section-37/GG0170S1	Wheel 150 feet - functional ability during 3 day assessment period [CMS Assessment]		Logical Observation Identifiers, Names and Codes (LOINC) LA26735-3: Not attempted due to medical condition or safety concerns
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